Wednesday, November 4, 2015

What if . . .?

A short article in the January, 2015, issue of The Atlantic, caught my attention. Entitled “Should the U. S. Bring Back Psychiatric Asylums?” the piece cited an article in The Journal of The American Medical Association, that made the case for doing just that.
The article struck a tender nerve in me. When Parrish was alive, his father and I often lamented the dearth of long term facilities for patients like him. He couldn’t manage his own life, and all the love and support in the world didn’t make his life easier for him—or for us. He needed to be in a sheltered environment where he could be monitored and medicated and treated humanely. Originally, the word “asylum” was associated with shelter and safety, a refuge of compassionate care for the chronically psychotic. 
Historically, state run asylums were reportedly places of less than optimal care. There were instances of neglect, brutal treatment, and dehumanization of patients. I know of what I speak.
In 1968, in nursing school, I did a psychiatric rotation in a mental hospital in Florida and was so traumatized by it, I blocked out most of the memories. In a recent visit with a wonderful friend who was in my class, she reminded me of the naked and caged patients who were systematically herded into a group shower and washed down with a garden hose. I remember assisting with electroconvulsive therapy (ECT or shock treatments) that was administered without anesthesia or even sedation. The patients were treated like animals, some of them kept naked because they tried to eat their clothes. 
I remember vividly the conversations with other students about the abject cruelty of some of the staff, not to mention the draconian treatments being administered by medical doctors. We all came away with a sense that such places shouldn’t exist. There had been those who agreed with us for quite some time.
Just a few months before he died, President Kennedy signed into law the Community Mental Health Act of 1963. The act earmarked $150M (a little over a billion dollars in today’s economy) for the establishment of community based mental health facilities. The civil rights movement of that era, along with the newly enacted law and the withholding of federal Medicaid funds for long term psychiatric facilities, began the wholesale dismissal of severely mentally ill patients into the general population. 
The outpatient world was not ready for the influx of chronically psychotic patients into its care. The shiny new community based treatment centers were not yet in place. Many patients were admitted to nursing homes and hospitals where they received intermittent and inadequate care that was much more expensive than inpatient care. Many become homeless and unmedicated, overwhelming halfway houses and homeless shelters. Hospital emergency rooms were overrun with patients waiting for psychiatric beds. Violent behavior among the sickest of the sick increased, and incarceration of psychotic patients became the norm. 
50 years after the passage if The Community Health Act of 1963, there are still not enough community based centers to facilitate the treatment of those who need them. In the state of Georgia, there are 20 facilities scattered over the state, which has 159 counties.  
According to The National Alliance on Mental Illness (NAMI) web page, “Approximately 26 percent of homeless adults staying in shelters live with serious metal illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.” Furthermore, “Approximately 20 percent of state prisoners and 21 percent of local jail prisoners have a ‘recent history’ of a mental health condition.”
Again, according to NAMI, “The lack of safe and affordable housing is one of the most powerful barriers to recovery. When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters and hospitals.” 
Many severely mentally ill persons, as did Parrish, rely on Social Security Income (SSI), which averages only 18% of the median income in the United States. Many—in spite of medication—are incapable of holding down a regular job because of their mood swings. When housing is available, the rent is adjusted to the patient’s income, but it is difficult to obtain. When patients are incarcerated or hospitalized, SSI is suspended, and when they are released, it can take months for the flow of money to begin again. Without resources, they are again forced into homelessness and many are cycled back through the criminal justice system.
Parrish was not only schizoaffective, he was addicted to benzodiazepines and alcohol, a syndrome not uncommon in chronically psychotic patients, who even when taking their drugs as prescribed, self-medicate their symptoms. He was intermittently homeless for the last several years of his life.
While homeless and living on the beach in Miami, in 2009, Parrish incarcerated on the notorious 9th Floor of the Miami-Dade County Jail, its “primary psychiatric unit.” In his book, Crazy: A Father’s Search Through America’s Health Care Madness,” Pete Early describes it in vivid detail. Because of his psychiatric disability, Parrish was imprisoned there as the result of stealing a 12-pack of beer from a convenience store. Conditions there were not unlike those in the asylums that were shut down decades ago. 
In his book, Early reports, “The first six ‘suicide’ cells each contained a combination sink and stainless-steel commode. They also held a bright-blue hard-plastic bed that was built so prisoners could be strapped spread-eagle onto it. There were no sheets in these cells, no blankets, no pillows, no other creature comforts.”
Mercifully, Parrish was turned around and dismissed within three days of his jailing. By a stroke of luck, he met with a counselor who, seeing in him something more than his mental disability, networked him into an outpatient program. He was by far the exception to the rule. 
When Parrish returned to Georgia in 2012, we quickly learned gaining access to the community based behavioral health centers is difficult. Months-long waiting periods for assessment and treatment as well as a paucity of inpatient stabilization beds are the norm. In the absence of funds for private care, the hospital emergency room became his de facto psychiatric care provider.
His life continued to be driven by his schizoaffective disorder and attendant alcoholism and drug addiction, and in January, 2014, he attempted suicide for the second time in less than a year. He was revived on a ventilator, and when he had been in the hospital for five days, the doctors at the hospital refused to send him home with me, insisting instead on transferring him to Savannah Regional Hospital, the community based facility which incredibly serves 24 counties. I was granted full guardianship of Parrish in April of 2013, but no one honored it, not even the doctors charged with his care. That doctor broke the law by not allowing me to make Parrish’s health care decisions, and I was powerless to do anything about it. Having heard Parrish’s descriptions of his treatment in the very facility he was being discharged to, his father and I would happily have admitted him to a private facility if given the option—damn the cost of over $800.00 a night.
Parrish was carried away by a sheriff’s deputy in handcuffs and ankle chains, like a prisoner, not a patient. He was in Savannah for a week, and when I picked him up, he had no discharge plan, but he did have a prescription for the very medication he took in his suicide attempt. He also had one for enough Valium to kill himself. Not stabilized on his medication, he ended up spending a month in the crisis stabilization unit of Gateway, the local community based behavioral health facility. 
After that stint in the stabilization unit, I made the decision, with the full support of his father, to bring Parrish home with me and find a way to make it work. I was terrified he would succeed in killing himself, or worse, be killed by someone else.
After his dismissal, Parrish was admitted to an outpatient program called ACT (Active Community Treatment). He was assigned a team composed of a psychiatrist, social worker, peer counselor, nurse and addiction counselor, was somewhat effective. The psychiatrist saw Parrish twice a month for a while, trying different medications. The team members were a mixed bag. His addiction therapist was the strongest member of the team, and she often saw him more than the required once a week. His social worker wouldn’t come in the house because she was afraid of my small dog. The nurse came in fits and starts, and Parrish saw his therapist once a month for a few minutes. That level of care may be sufficient to keep some patients at home, but it wasn’t for Parrish. He needed long term inpatient treatment. We tried, we really did, but here were frequent visits to the emergency room for symptoms of severe mania. 
There is an unmistakable pattern in this story. Not only was Parrish marginalized by the “system,” I was also. I was systematically denied my rights and responsibilities as Parrish's guardian. Doctors and law enforcement personnel routinely broke the law when they refused to allow me to speak for him. Once, I was prevented from being in the room with him by a police officer in the emergency department.
He was hospitalized several times during 2014, mostly in a private facility, but his final admission, after an extended period of extreme mania and another encounter with the police (who refused to even glance at my guardianship papers), was to the Gateway crisis stabilization center on January 7, 2015. I will forever regret that decision. 
He was heavily sedated, which is not uncommon in the stabilization of mania. The hope is to sedate the patient and gradually decrease the medication over a few days or weeks, hoping he will cycle out of the manic phase. I believe the staff at Gateway, charged with his care, failed to monitor Parrish’s condition closely enough. Late in the morning of January 7, he was discovered to be in respiratory distress and taken by ambulance to the local emergency room. He died less than 12 hours later, connected to a respirator.
According to the autopsy report, Parrish died of pulmonary edema secondary to a multi-drug overdose. Pulmonary edema is the build-up of fluid in the spaces outside the blood vessels of the lungs. It is almost always caused by a heart problem, but Parrish’s heart was healthy. Autopsy revealed that both of his lungs were so congested with fluid, they each weighed twice as much as normal.
I am not equating Parrish’s treatment with the horrors I witnessed as a young woman, but it is clear to me he wasn’t monitored as closely as he needed to be. His condition might have been recognized earlier if anyone had routinely listened to his chest. Gateway certainly failed Parrish and everyone who loved him. But it wasn’t only Gateway who failed him. There is a sound argument for having in place facilities for the long term, even permanent, care for the severely mentally ill who are not functional. 
Yes, I am advocating for bringing back the asylum. There are those who cannot, even when they try as hard as they can, manage their own lives and whose loved ones are unable to cope. Ours was a classic example of such a calamitous and intractable situation. I don’t think I’ve ever felt as powerless as I did during the last year of my son’s life.
    What if, in 1963, some of the monies earmarked for community based centers were instead used to close down the worst of the asylums and clean up those remaining? As Parrish got sicker and sicker, what if his father and I had the opportunity to provide him access to a place of sanctuary, refuge and compassionate care? I certainly don't support the wholesale institutionalization of the mentally ill. In today’s world of better medications and therapies, it’s simply not needed for most patients. But I believe Parrish would have benefited from long term, and not necessarily permanent, inpatient care. I believe it would have saved his life.

Copyright 2015 cj Schlottman

Friday, July 3, 2015

Fire the Paralegal and Hire Me

I had thought to end this blog with my last post, but the story of Parrish is hardly written. For the last two months, I have been trying to learn what happened to him, why he died so suddenly of what was apparently a total body shut-down. 

At first I was too sad and tired to even try. I spent 10 weeks hiding from the inconceivable truth that my son, my only child, was dead and no one could explain why. I discovered Netflix and spent hours—day and night—binging on dramas that were so sick and violent, they took me outside of my head. I drank more vodka that I should have. I stopped getting dressed and wearing makeup and ate Reese’s Peanut Butter Cups by the pound. I gained weight. I cried a lot. I was a mess. I woke in the night, my head aching as though there were rocks rolling around crashing against my skull.

About two months ago, I woke up. I got mad. I got “I want to kill somebody” mad. I started actively working to learn something—anything—about what happened to P. I checked with the law firm and learned they hadn’t received any of the records they requested. I began to work at getting the information myself. I left messages with the coroner and the police officer who opened a case on the night of P’s death. None of my calls were returned. I became obsessed. It was as though I didn’t exist to those people. 

I, the grieving mother, couldn’t even get anyone to take my calls.  I continued to obsess. I called five separate numbers for the facility, three of which dead-ended at voice mailboxes with no names and that were full. I Googled the acting director and called his number. At least the voice mail greeting included his name and the box wasn’t full, so I left yet another message.

Miracle of miracles, I got a call back in less than an hour. I made my request to the clerk on the other end of the line, and she assured me the records had been delivered to the law firm. I asked her to send them again. That was Friday afternoon. The records were delivered via fax on Monday morning.

Feeling empowered by my small success, I continued to call the coroner’s office, and on every occasion, a very nice woman said she would have someone call me. No one did. I finally, at the suggestion of a friend, called the Probate Court to see if they could help me, as P’s legal guardian, get my hands on his autopsy report. The very kind clerk didn’t have any tips for me, but she did provide me with the name and phone number of the president of the Coroners Association of Georgia. 

So, I called him. I called him and ratted on the son of a bitch who refused to respond to my requests. I squealed on him like a little pig. The kind man expressed surprise at the treatment I was receiving and promised to look into it. 

Then I got in my car and went to the police department to get a copy of the report of the case that was opened on the night of P’s death. Police reports are public record, and anyone can obtain copies as long as the cases are not active, a fact I learned from surfing the web looking into the Georgia Open Records law.

I tucked the paper into my folder of notes, and as I was walking toward the door, turned and asked the clerk how I could go about getting a copy of the 911 incident report generated when P was taken to the hospital. She directed me to the fire department, which was conveniently located two doors down, and guardianship documents in hand, I presented myself there. 

The fire department made copies of my papers and my driver’s license. They were kind and sympathetic, but their computers were down. Paranoia bloomed in the back of my brain. What this yet another roadblock being thrown up in my face? I almost started crying. The clerk took a look at my face and called a lieutenant from the back to talk to me. I spilled my story all over him, and, astonishment in his eyes, he promised to call me the minute they could print out the information I needed. 

Then I asked him if he knew how to get my hands on the autopsy report. He didn’t know but promised to look into it and call me the next day. I left, feeling a little spark of hope, and turned back toward The Island. My phone sounded before I got to the causeway. It was the nice lady who answers the phone for the coroner! She suddenly had information for me. Did the president of the Coroners Association give them a ring? I’m choosing to believe he did. She gave me the name and number of a clerk in the medical records department at the hospital.

"Just call her, honey. She can help you."

It was too late to call when I got home, so I had to wait until the next morning. Before I could make the call, the nice lieutenant from the fire department called to say the 911 report was available, and he also gave me a name and a number in medical records. When I called, the clerk told me to bring my ID to her department and sign a form, and the autopsy report would be mine. Who knew? Why in the name of hell didn’t the coroner’s phone-lady just tell me that when I started calling her weeks before?

I decided to drive out to the fire department first. Report in hand, I returned to my car and sat in the parking lot reading it. After three lines, my mouth fell open. By the time I finished, I was weeping as violently as I did on the night of January 17, when P’s heart stopped. Air conditioning blowing into my face, I dropped my head on the steering wheel and wept until I was all wept out. All of my wounds were ripped open. I thought my heart burst. A full ten minutes later, I could see well enough to drive to the hospital.

It only took a few minutes to get the autopsy results. I slid the form into my folder, afraid to look at it until I could get home and pour a vodka. I read it through, then I read it through again. My paralyzing sadness morphed into a rage I have never known. I snatched a pillow from the sofa and screamed into it. I screamed until I was out of breath and the pillow was wet with drool. Then I collapsed onto the sofa and the tears returned. 

I woke in the night, unfolded myself and sat up. For a moment, I wondered where I was. It struck me in the head like a physical blow—the  reports, both of them. I stumbled to the bathroom and brushed my teeth before climbing into bed. I slept fitfully and woke early. I reread the material. 

Because we have engaged professional legal advice, I can’t share any of the facts I uncovered. I can tell you, though, that I have an unsigned death certificate that in no way bears out the facts learned at autopsy. My next project is to go back to the police department and demand to see a detective. I want someone to explain to me why the “case” opened on the night of Parrish’s death was closed the next morning.

I need a break, and I’m leaving in the morning to attend Rosemary Daniell’s Annual Zona Rosa Writer’s Retreat on Tybee Island.

Happy Fourth of July.

Copyright 2015 cj Schlottman 


Monday, May 18, 2015

What Happened?

Nearly a year has passed since my last post on this blog. After two suicide attempts during the first four months of 2014, Parrish’s mental health declined. As hard as I tried to convince myself that things would be better, his manic episodes became more frequent and severe. He asked me to stop blogging about our life. He was ashamed and embarrassed about his illness, so I agreed.
In spite of his brain syndrome, schizoaffective disorder, there was a palpable goodness about him. He was kind and gentle and generous and had impeccable manners. He was a Southern Gentleman plagued with a mental disorder that sometimes masked his goodness. Everyone who knew him as a child remembers him as the happiest little boy imaginable. Nonetheless, his illness was progressing.
He used alcohol to treat his manic episodes, and for a while we used a breathalyzer to discourage drinking. Before long, though, when I asked him to blow into it and he had been drinking, he exploded with paranoia and began railing against me for all my past sins, real or imagined. I spent too much energy being angry, not just at Parrish but at his disease—the unfairness of it, it’s intractable hold on him, the toll it took on me. I am ashamed of how many times I lost my temper.
I resorted to putting a deadbolt lock on my bedroom door and wearing the key on a plastic spiral bracelet in order to make sure he didn’t get his hands on any unauthorized medication. All this I did in an effort to protect him from himself, to throw roadblocks in the way of his efforts to treat his pain, his unrest, his feelings of guilt and unworthiness. But I was as powerless over his bipolar symptoms and his drinking as he was.
The summer was hard. Parrish took long bike rides around The Island, trying to burn off some of the energy, the manic force that filled his head with racing thoughts and the desire to drink. Sometimes he got relief, but at others he arrived home in the same state of unrest and confusion he had tried so hard to overcome. 
He saw a therapist and an addictionologist every week. There were medication changes and short periods of improvement, but his internal battles continued. When we moved into this house, he often told me it gave him a sense of belonging. I thought he would stabilize and feel grounded, and have a sense of permanence, and for a while, it seemed to be. 

There were good times. Often we drove to The Village Pier to see Lawrence, his father, the senior active harbor pilot for the port of Brunswick, board the pilot boat and go out to sea and bring in a ship. One day in July, we rode 12 miles out with him and watched him climb the ladder to the ship’s elevator, which would take him to the wheelhouse to assume command of the ship. Parrish was very proud of his dad, but it was a bittersweet pride. He felt guilty because he wasn’t able to become a harbor pilot, a profession that is traditionally passed down from father to son. While in college, he was a boatman for his dad, but he wasn’t emotionally equipped for the dangerous job. We were never able to assuage his feelings of not having measured up.
We frequently drove down to The Village for yogurt and ate it on a bench overlooking Saint Simons Sound. We had supper at a restaurant overlooking the water at least once a week.  I have always believed in the healing power of the ocean, it’s steadfastness, the negative ions it produces that soothe our souls and calm our minds. Every now and then, this sweet and tortured man’s spirit could be lifted by the salt air.

There were also periods of dark depression when he spent days in bed, sleeping almost around the clock, arising only to eat a bowl of cereal or some other snack. And there were angry outbursts, periods of confusion and days without sleep. I armed the security system at night in case he got up and left the house without realizing it. It sounded at 4:00 AM one morning early in September, and when I found him standing in the carport, he had no idea why he was there. 
October was a sine curve for us—extreme episodes of angry mania graphed against low troughs of depression. By the third week of that month, Parrish’s behavior was so erratic, I was afraid for his safety. So, his doctor admitted him to a private behavioral health facility, where he stayed for nine days. At first he was heavily sedated and monitored carefully. Then the sedation was gradually lifted, and he came home more in control, more himself, though he continued to struggle.
One day soon after he got home, when he was sober, he sat down in the chair across from me in the sunroom, where I was reading the paper. Manic, his heels worked furiously against the floor and he shifted in his chair.
“Mama, I know you get mad when I drink. I don’t blame you, but you just don’t understand. It’s not about you. I love you more than anything in the world, and I never want to hurt you, but I end up doing it anyway, because I am so sick!”
He took a long pull on his cigarette. I remembered other times when he told me much the same thing. Maybe he was right. Maybe I just didn't get it.
“Nobody wants to feel the way I do—nobody. When I’m manic, I can’t concentrate long enough to read a book or watch a TV program. Who would want this? I feel guilty that I live at home with my mother at age 45 when I should have a decent job and a family of my own. All I want is to be halfway normal. When the noise in my head gets so loud I can’t think or hear or focus, I will do anything to make it go away, even for a few minutes. I can’t smoke a whole cigarette without putting it out and looking for some other distraction. I can’t sit still or have a clear thought about anything because of the tornado in my head.”
I sat across from him and watched helplessly as he knuckled tears of frustration from his handsome, tortured face. 
“That’s when I drink. At the risk of damaging my relationship with you and Daddy, even at the risk of my own safety, of going to jail, I drink because for a little while—just a little while—the noise in my head goes away. Even if it only lasts a few minutes, it’s worth it. But then I can’t stop drinking, and you know what 
happens next. I’m just drunk and angry and sad and sick and manic, and the noise is back. Sometimes I want to die; I really just want to go to sleep and not wake up. You think if I just don’t drink, everything will be okay. If everything was okay, I wouldn’t need to drink! Don’t you see? My brain is broken in a million pieces.”
I got up and walked over to where he sat, heels still pounding the floor. He stood and gave me a halfhearted hug. It was the best he could do.  
“I’m so sorry, P. I’m so very sorry. You’re right. I can’t know how you feel. But I can accept what you say. It’s your reality, your truth, and I’ll try to be more patient. I know it’s unfair for me to get mad at you and lose my temper when it’s your illness I hate, not you. I couldn’t love you any more than I do, but I’m beginning to understand that loving you won’t make you well. We can’t give up, though, we have to keep looking for a plan that will work. And you know I have to ask, are you feeling suicidal now?”
“No,” was his reply, and he dismissed my suggestion that he call his psychiatrist. 
There is something so wrong about not being able to help one’s own child. I was overcome with helplessness and, yes, guilt. Earned guilt? No, I didn't make my son sick, but the mother in me grappled with the notion there was something I was missing, something more I could do to make Parrish’s life better. I never stopped believing if I just loved him enough, there would be a miracle.
There were a few weeks, from mid-November until mid-December, when P was sober and focused and calm. Always attractive, he was even more so without alcohol in his system. He dressed every day in crisp khakis and colorful shirts and sweaters that made his blue eyes sparkle. On cold mornings, he delighted in building a fire for us to share. I can’t explain why we were given that time, but I will forever be grateful for it. He was on a new medication, and maybe that’s why we had that incredible, peaceful reprieve. Our friend Marnie came for Thanksgiving. Friends from high school, they fell in step and really had a good time. We had friends over on Thanksgiving night, and they were taken by Parrish’s charm, his impeccable manners, his sense of humor and his obvious intelligence. It was the best Thanksgiving for me in many years.
I was hopeful we had found the answer, the right medication, but in mid-December, he started drinking and was soon in crisis again. So, he went back to the hospital on December 20, for three nights. He was little improved when he was dismissed, but we all wanted him home for Christmas. His dad came over, bringing gifts (which were carefully chosen by his incredible wife, Melissa), but Parrish was unsettled, unfocused, suffering an inner turmoil that was visible on his face. He couldn’t enjoy the day, the time together or the gifts. When the paper and ribbons had been stuffed in the trash and the gifts organized, he excused himself and went to bed. 
On January 5, Parrish rode his bike across the Torras Causeway, a four lane road that spans the salt marsh between Saint Simons Island and the city of Brunswick on the mainland. Motorists routinely exceed the 50 MPH speed limit, even when crossing its five bridges, one of which arches a half mile across the Mackay River. It’s a dangerous ride, even with the bike path that’s provided. He presented himself at the hospital emergency room and asked for help to calm his extreme mania. 
He was released to me after an inadequate dose of medicine and was just as sick when he got home as when he arrived there. Two days later, having not slept since returning from the ER, he had a manic episode that once again sent him for impatient stabilization. That time, he was admitted to the state-run facility in Brunswick.
We spoke on the phone every day. He was deeply sedated and thick-tongued, but he could organize his thoughts a little, and with some effort, I could understand part of what he was saying. He never hung up without telling me he loved me, and I always told him back. It was something we did, even when things were at their worst. I was concerned about his level of sedation, but when his doctor called me to report on Parrish’s progress, he assured me he was decreasing the medication dose and Parrish would soon be more alert, and he could start thinking about letting him come home.
On January 17, ten days after admission, his doctor called to say Parrish’s respirations were rapid, and he was sending him to the ER for evaluation. It was a little after 11:00 in the morning.  Going to the emergency room had become part of our life, and I wasn’t alarmed. It’s not uncommon for bipolar patients to have rapid and shallow respirations, even hyperventilate. I waited a reasonable length of time for the staff to get him settled, then called to check on his status. His nurse said couldn’t talk; she was busy taking care of him. 
There was no trace of urgency in her voice, but as I hung up the phone, my breath caught in my throat. Something was wrong; I could feel it at my very core. Anxious, adrenaline pumping, skin prickling, I grabbed my purse and drove to the hospital and repeated to myself, He’s okay, he has to be okay. He’s always okay, not matter what happens, he’s always okay. He survives, always survives. 
I arrived at the ER to find my son in a coma, a tube snaking out of the side of his mouth, taped to his cheek and connected to a ventilator. Monitor wires and cascades of IV tubing cluttered the space above him. His wrists were tied to the sides of the bed with thick brown leather restraints, and his abdomen was grossly distended and hard. He was completely unresponsive, even when I climbed under the tubing to kiss is sweet face and put my lips to his ear and assure him everything was okay.
“I’m here, P. It’s Mama. A machine is breathing for you so you can get better. You’re going to be just fine.”
As a nurse, I could see from the numbers on the monitor his blood pressure was barely enough to sustain circulation and his oxygen saturation was too low to support his vital organs. A chill shot through me. I opened his right eye and saw a spark of hope when the pupil reacted to the light in the room.
“What happened?” I looked at the nurse who stood on the other side of the bed, eyes fixed on the bedspread. “What in the name of God happened to him?”
She looked up. “He has severe pneumonia and an intestinal obstruction. I’ll get the doctor for you.” Her face was kind and sad.
I climbed back under the tubing and reached for Parrish. I held his tethered hand and leaned close to tell him how much I loved him. It didn’t occur to me to ask why he was tied to the bed when he was clearly unconscious.
The doctor stepped into the room, his expression solemn and drawn.
“What is this? What could possibly have caused this shutdown?” I croaked.
“Mr. Gray’s lungs are completely filled with pneumonia, so we’re breathing for him. He has an intestinal obstruction, but he’s too critical to operate. We’re going to move him to ICU and see if he can rally. It doesn’t look good, though. He’s a very sick man.”
The voice in my head chimed in. He has to be okay, he’s always okay. He’s been near death before.
“But how did he get so sick so fast? I just talked to him yesterday.”
He just shook his head and said, “We really have no way of knowing at this point.” 
Shoulders sagging, arms dangling at my sides, I stood and stared at this man who offered me so little hope. My stomach lurched at the wave of realization that this time could be different. Parrish might not come back from this sudden and devastating medical emergency.
“But what happened?” I repeated. I was too stunned to formulate the questions that would give me meaningful answers. Did Parrish stop breathing in the ambulance or after he arrived at the hospital? Was he conscious when he  got there? Did he say anything? Was he in pain? What caused the obstruction? Utterly alone and terrified, I stood mute, paralyzed. I cradled my face in my hands, then looked back up at the doctor, whose voice had become distant and faint. What was I hearing?
“Should I call my family?”
“Yes.” he said. “I’m very sorry.” Then he was gone.
I stood in the doorway of Parrish’s room and punched Lawrence’s number into the pad on my phone. I told him where we were and about the ventilator, but I didn’t say I thought P was dying. I wasn’t sure I believed it myself. He came right away, and while I waited for him, I called my brother and some other family members who all repeated the question that was whirling around in my head. What happened? 
While the staff moved Parrish to ICU, I waited in the parking lot for Lawrence. When I saw his car pull into a parking space, I ran to him and all my resolve to stay calm melted away.
“He’s not going to recover this time,” I blurted into his shoulder. “His lungs are so full of pneumonia he can’t breathe and he’s going to die.” My heart was swollen with fear and shock and disbelief at my own words. My breath came in short spurts punctuated by deep sighs.
In his gentle way, Lawrence said, “There’s probably something they can do for him.” His face was pale, and I could read the same fear in his eyes that I am sure was in mine. 
“You should call Melissa and tell her to come,” I squeaked.
“Maybe they can do something . . .”
“You’ll understand when you see him,” was all I said.
We went to the waiting room to sit and wonder. We spoke in whispers as though saying it all out loud would make it true. I tried to prepare Lawrence for the sight of his son, completely unresponsive, skin dusky, belly distended, tubes everywhere. Melissa arrived, kind and comforting, the strong one we both needed. Time passed, I don’t know how much, but I finally got up and walked down the hall and rang the bell of the intensive care unit. A nurse responded and said we could all come in. Lawrence stopped in the doorway of Parrish’s room and a sob, almost a keening, rose from his throat, and I thought he might collapse. 
“Take a breath,” I said. “Go over and take his hand. Talk to him, tell him you are here. You too, Melissa. He needs to know we are all here.”
And we took turns talking to P, assuring him that he would be okay. I know he heard everything we said. I am absolutely certain of it. Every time one of us talked to him, his blood pressure and oxygen levels improved marginally, then returned to their unpromising baselines. Yes, he knew we were there.
Denial is a powerful emotion. I could not process the truth and instead began to prepare for a long siege in ICU after which P would be coming home. Melissa drove me to my house, and I gathered a toothbrush and my medicine and dropped them in my purse. I sat down on the blue loveseat in the den and smoked a cigarette, made a couple of calls, caught my breath. It never occurred to me that Parrish might die before we got back to the hospital.
We had been home for about 45 minutes when we started back to the hospital. Five minutes into the drive, my cell phone buzzed. It was the nurse, urging us to come back quickly.
I rushed into the room to find P still alive but with monitor readings indicating he was fading. We continued what was by then, undeniably, our death watch, taking turns with Parrish, doing everything we could to comfort him and one another. The nurse came in and untied P’s hands. Why were they tied in the first place? Was he struggling in the ambulance or after he arrived at the ER? I sat at his side and used the tail of his hospital gown to blot my tears and wipe my nose.
We tried not to weep, but we did, our faces stricken with shock. We held one another. None of us could sit down for more than a few minutes. The three of us shared one Coke, and we never finished it. I couldn’t keep my eyes off the monitor. I wanted to throw a blanket over it, or better yet, hurl something at it, break it. But I kept staring, thinking I could will the numbers to change.
I have never missed Clint as much as I did that night. I wanted him there to wrap me in his arms and protect me from the unthinkable reality of P’s dying. I wanted to cry on his shoulder, bury my face in his neck, feel the incredible warmth and love of him. Even with the love and support of everyone in the room, I felt hopelessly alone.
A few minutes after 9:00, face buzzing with fear and feeling as though my head would explode if I didn’t get some air, I took the elevator downstairs to the cold air of the parking lot and lit a cigarette. After two puffs, my cell phone sounded, and I knew. 
“Come quick,” Lawrence whispered. His numbers are worse.”
I scrambled back upstairs to find that Parrish’s heart had stopped beating at 9:15. I wanted to crawl in bed with him, put my ear to his chest, listen for any sign of life. The nurse lowered the side rail for me, and I kissed his beautiful face, lay my head on his silent chest, felt as though my own heart would stop beating. Overcome with a sadness so profound I almost forgot to breath, I felt as though I would melt into him.
How could he be dead? How could he possibly be dead when he was alive this morning, when I talked to him yesterday?
I went to Lawrence and we wept into one another’s shoulders, barely able to stand. Melissa embraced us both, but there was no comfort, only shock and despair. 
We stayed with Parrish until the staff was ready to move him to the morgue. Not wanting to see him transferred to a stretcher, covered with a sheet, and wheeled out by people who knew nothing about him—who had never seen him smile or laugh, people who didn’t know he once won $500 in a trivia game because he knew the zip code of the Pentagon, and he could name every county and county seat in Georgia. They didn’t know that underneath all his sickness, he was a sweet and generous soul. We didn’t want to see him carried away by strangers.

I didn’t sleep that night. Four months later, I am still awakened in the night by the vision of my only child on an ICU bed, dying before my eyes. We still don’t l know why he died the way he did. We finally got some professional help to look for answers, but the question remains, “What happened?”